Hand Washing: How Much is Too Much?

(HealthNewsDigest.com) - Parsippany, NJ, June 2014 - Washing your hands - often - is one of the best ways to prevent the spread of colds, flu, food-borne illnesses and other infectious diseases. But just as there many people who would do well to consistently heed that advice, there are many who don't need to be reminded. They are the ones who are so worried about germs that they take particular care in public places to avoid touching surfaces that may be contaminated and make frequent use of hand sanitizers and antibacterial soaps in an effort to minimize risk. For most, these precautions put their concerns to rest and are part of their daily routine. For some, however, concern about cleanliness and germs is an obsession and leads to compulsive, often ritualized behavior.

"Obsessive fear of germs or dirt and the compulsion to wash the hands over and over is one of the most common manifestations of obsessive-compulsive disorder," says Dr. Francine Rosenberg, a clinical psychologist and anxiety specialist with Morris Psychological Group. "For people who suffer from OCD, hand washing goes well beyond a preoccupation with cleanliness. It is excessive behavior whose real purpose is to reduce intense feelings of fear and anxiety. The distinction between concern about germs and obsessive-compulsive disorder is based on the degree to which the concern affects and disrupts - even dominates - one's life."

Defining OCD and excessive hand washing

Obsessive-compulsive disorder is an anxiety disorder characterized by uncontrollable fears and thoughts that compel repetitive, ritualized behaviors that are performed in an attempt to drive out the obsessive thoughts. OCD sufferers generally realize that their obsessive thoughts and compulsive behaviors are irrational but feel helpless to resist them. Those with hand-washing compulsions are obsessed with fear of contamination and often wash their hands repeatedly until they are chapped, raw and even bleeding. They may also ritualize the process, such as by washing each finger individually and in a specific order. An interruption to the ritual might compel starting over - and over - from the beginning.

"People with above-average concern about germs and dirt will wash their hands very thoroughly and may avoid touching the faucet when turning off the water so as not to re-contaminate their hands," says Dr. Rosenberg. "They may also make liberal use of hand sanitizers between washes. But they will go about their day without undue distress about cleanliness. For those with OCD, however, a single washing is never enough. Even after multiple washings, the anxiety associated with fear of contamination will continue to impinge on their thoughts to the point of disrupting their lives. And washing their hands does little to relieve the anxiety."

A precise cause of OCD has not been pinpointed. It is generally thought that there are biological, psychological and environmental factors involved. While it is known that there are changes in the brains of people with OCD, there is no scan or test that can diagnose it definitively. Diagnosis is based on a comprehensive interview with a mental health professional. Psychotherapy, with or without medication, is often an effective treatment for OCD, particularly cognitive behavioral therapy, a short-term, structured approach that focuses on learning ways of dealing with obsessive thoughts without resorting to compulsive behaviors.

Tips on when to seek help for OCD

"Embarrassment often causes people to suffer with OCD for years before seeking help and to try to keep their behavior hidden even from those close to them," says Dr. Rosenberg. She emphasizes that there is a clear distinction between concern with cleanliness and OCD and suggests that anyone suspecting the disorder ask himself or herself these questions:

After washing your hands, are you still worried that they aren't clean enough, that you might have missed a spot or not washed correctly? Even after repeated washing are you still fearful or anxious about contamination?

Do you have an elaborate routine for washing your hands? Do you wash according to a particular sequence or count? Do you frequently start over for fear of having gotten it wrong?

Are your hands often red, raw and chapped?

Do you go to extremes in avoiding places or situations that you fear might expose you to germs or dirt? Do you avoid shaking hands or touching surfaces in public places?

Do your anxiety about contamination and efforts to alleviate it interfere with your relationships and daily activities?

"Answering 'yes' to several of these questions might indicate OCD and warrants consultation with an experienced psychologist," Dr. Rosenberg concludes. "The disorder is readily treatable. No one needs to live with the anxiety and depression caused by obsessive thoughts and compulsive behaviors."